DOCSLIB.ORG

Paraneoplastic Syndromes in Lung Cancer

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Paraneoplastic Syndromes in Lung Cancer Chapter 2 Paraneoplastic Syndromes in Lung Cancer Dilaver TasDilaver Tas Additional information is available at the end of the chapter http://dx.doi.org/10.5772/intechopen.79127 Abstract In recent years, the incidence of lung cancer (LC) has been increasing throughout the world and is the most common type of cancer in all regions of the world, occurring more frequently in men than in women. Paraneoplastic syndromes (PNS) refer to clinical conditions that develop in relation to tumors, without physical effects of the primary or metastatic tumors. The development of PNS is not associated with the size of the primary tumor or the extent of metastases. It is usually seen in small-cell lung cancer (SCLC) as well as other types of lung cancer. PNS developed in almost 1 in 10 patients with lung cancer and it may be an indicator for the diagnosis of lung cancer and it can be seen during later stages of cancer or at the time of cancer recurrence. Accordingly, the identification of these syndromes can be helpful in the early diagnosis of occult cancers, allowing timely treatment. PNS decreases the quality of life of the patients with cancer and thus requires specific treatment. Moreover, these conditions can be used as a marker of cancer activity and can predict prognosis. In this section, a detailed description of PNS is provided. Keywords: lung cancer, small-cell lung cancer, non-small-cell lung cancer, paraneoplastic syndromes 1. Introduction 1.1. Definition The term “paraneoplastic syndrome (PNS)” refers to tumor-related symptoms and findings that are independent of the direct, local extent or physical effects of metastases. PNS develops in response to the effects of hormones and cytokines released from cancer cells, or due to the immunologic response of cancer cells [1, 2]. In this regard, there is no single mechanism © 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. distribution, and reproduction in any medium, provided the original work is properly cited. 24 Lung Cancer - Strategies for Diagnosis and Treatment underlying the development of PNS, and potential mechanisms have not yet been clearly understood. On the other hand, several tumor-secreted proteins that may be associated with the development of PNS have been defined in the recent years. Generally, the ectopic produc- tion of peptide hormones with hormonal activity and immunological mechanisms can be seen in patients with PNS. The diagnosis and treatment of PNS are complementary parts of lung cancer (LC) manage- ment. PNS may involve several organs and systems, and so may therefore result in neurologi- cal, dermatological, hematological, nephrological, rheumatologic, metabolic, immunologic and constitutional signs and symptoms. 1.2. History In 1865, Armand Trousseau, a French internal diseases specialist, stated that the identification of unexpected or migratory thrombophlebitis could indicate an occult visceral malignancy [3], and today, the development of superficial migratory thrombophlebitis related to visceral cancer is known as Trousseau syndrome. An Austrian dermatologist, Ferdinand von Hebra, underlined the significance of internal disease in the etiology of several skin manifestations such as urticaria, generalized pruritus, xanthoma, and pemphigus. In 1868, he further stated that skin pigmentation could be an indicator of cervical cancer [4, 5]. In 1890, a French physi- cian named Auche defined peripheral nervous system involvement in patients with stomach, pancreas, and uterus cancer [6], while acanthosis nigricans associated with malignancy was reported separately by Pollitzer and Janovsky in 18907 []. Later, Brown identified the Cushing syndrome in a patient with small-cell lung cancer (SCLC) in 1928 [8], and in 1933, neuropathy development was reported in a patient with oat cell carcinoma (small-cell lung cancer) [9]. Guichard and Vignon used the term “paraneoplastic” for the first time in 1949 when they identified central and peripheral neuropathies in a patient with cervical cancer [10]. In 1957, Schwartz et al. reported hyponatremia in a patient with LC 11[ ]. In 1967, Bartter and Schwartz defined the syndrome of inappropriate antidiuretic hormone secretion (SIADH) 12[ ]. The relationship between the neurological PNS and LC was first suggested by Oppenheim at the end of the nineteenth century [9]. In the following years, etiologic and pathogenetic studies were carried out to evaluate the relationship between PNS and cancer including LC. Additionally, new PNS definitions and new developments have been made which are still ongoing. 1.3. Epidemiology LC is currently the most common type of cancer throughout the world [13]. Due to the high incidence rate of LC and the relatively high frequency of PNS in SCLC cases, LC-related PNS is more common than other types of cancer [14–17]. However, it is difficult to estimate PNS frequency due to challenges in the identification of PNS and uncertainty in the differentia- tion of its symptoms because of the underlying disease. PNS can be seen in all age groups of patients with cancer. However, due to the nature of cancer, it is more common in middle- aged and older individuals. PNS develops in 1–7.4% of all patients with cancer, although it is estimated to develop in 20% of all patients with cancer [14]. The inclusion of generalized malignancy symptoms, such as cachexia and fever, increases PNS frequency up to 70% [18]. Paraneoplastic Syndromes in Lung Cancer 25 http://dx.doi.org/10.5772/intechopen.79127 PNS can occur both in patients with SCLC and with non-small-cell lung cancer (NSCLC). SCLC has a neuroendocrine origin and PNS is more common in such cancer types. PNS is seen by 7–15% of all patients with LC. Systemic symptoms and findings of PNS develop in 50% of patients with SCLC and almost 10% of patients with NSCLC [19]. PNS develops secondary to LC and increases the severity of the disease. It is therefore crucial to recognize PNS in these patients. Incidences of PNS will increase in the coming years thanks to the improvements in diagnosis and treatment of LC as well as in the diagnosis of PNS. 1.4. Pathophysiology PNS may develop under the effects of substances released by the tumor or as a result of the cross-reactions between tissues and the antibodies produced against the tumor. Studies investigating the pathogenesis of PNS offer some evidences that PNS develops based on different pathogenetic mechanisms, such as: 1. The production of special substances by tumor cells, leading specifically to the develop- ment of PNS. These substances may be hormones, growth factors, vasoactive peptides, cytokines, enzymes or other signaling molecules. 2. Abnormal immune response of the host organ to the neo-antigens produced by the tumor or to other tumor products [7, 18, 20]. Endocrinologic PNS generally develops due to the increased production of hormones or hormone precursors by malignant cells. The best example for this is paraneoplastic Cushing syndrome seen in patients with SCLC [21]. Paraneoplastic hypercalcemia is an example of PNS associated with cytokine production. Some cytokines (IL-1, 3, and 6, prostaglandins, TGF-α, TNF-α [lymphotoxin], and TNF-β [cachectin], etc.) that are synthesized by the malignant cells may result in hypercalcemia by activating osteoclasts [22]. Cancer cells are recognized by the immune cells and lead to the production of antibodies. As cancer cells are identical to normal cells in nature, the antigens on the cancer cells are similar to those of natural cells. Therefore, the formed antibodies may have a cross-reaction with normal tissues. This pathophysiological condition is most commonly seen in neurological PNS [23, 24]. The main mechanism underlying above-described pathological response in patients with LC and other types of cancer still presents an unanswered question. The most appropriate answer to that would be inappropriate gene expression (IGE). IGE may be described as the formation of an inappropriate gene programmed to produce tumoral proteins in cancer cells. This may lead to the development of new disorders that will negatively affect patient well-being. Thus, the quality of life of the patient is impaired and the severity of the disease increases [18]. Genetic studies that will be performed in the future to identify IGEs in cancer patients will allow the early detection of PNS, even before the clinical diagnosis, and more importantly, will be helpful to identify malignant formations. 26 Lung Cancer - Strategies for Diagnosis and Treatment 2. Paraneoplastic syndromes The diagnosis of PNS is relatively challenging, as lesions may develop in regions distant to the cancer and may not resemble a cancer-related disease, and the disorder has benign forms in general as well as malignant forms. PNS should be suspected in the presence of below char- acteristics: absence of a defined etiology for the associated syndrome; correlation between the time of diagnosis of the syndrome and that of cancer; clinical and histological remission after complete surgical or chemotherapy treatment and a worsening of symptoms due to tumor residue [25]. Although PNS may be associated with a lot of malignancies, they are associated most com- monly with lung cancer, specifically SCLC. Humoral hypercalcemia and SIADH, which is seen in orderly squamous cell and SCLC, are the most common PNSs. Multiple para- neoplastic syndromes can be seen in patients with SCLC. In the literature, there have been patients with two or more paraneoplastic syndromes associated with SCLC, even though rarity. Paraneoplastic syndromes usually have a course parallel to the underlying malig- nancy. Treating the underlying tumor is the first choice and symptomatic therapy can be useful [2, 26–29].
Load more

Recommended publications
  • Paraneoplastic Syndromes in Lung Cancer and Their Management
    359 Review Article Page 1 of 9 Paraneoplastic syndromes in lung cancer and their management Asad Anwar1, Firas Jafri1, Sara Ashraf2, Mohammad Ali S. Jafri3, Michael Fanucchi3 1Department of Internal Medicine, Westchester Medical Center, Valhalla, NY, USA; 2Department of Hematology/Oncology, Marshall University, Huntington, WV, USA; 3Department of Hematology/Oncology, Westchester Medical Center, Valhalla, NY, USA Contributions: (I) Conception and design: All authors; (II) Administrative support: None; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: None; (V) Data analysis and interpretation: None; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Mohammad Ali S. Jafri, MD. Department of Hematology/Oncology, Westchester Medical Center, Valhalla, NY, USA. Email: [email protected]. Abstract: Paraneoplastic syndromes are most frequently associated with lung cancer. This review considers a variety paraneoplastic syndromes associated with lung cancer and discusses their pathophysiology, clinical features and management options. Keywords: Paraneoplastic syndromes; lung cancer; thoracic oncology Submitted Feb 12, 2019. Accepted for publication Apr 25, 2019. doi: 10.21037/atm.2019.04.86 View this article at: http://dx.doi.org/10.21037/atm.2019.04.86 Introduction PTHrP production (parathyroid hormone related-protein), it is referred to as HHM. Paraneoplastic syndromes refer to the remote effects HHM is observed in a variety of malignancies such as associated with malignancy which are unrelated to direct breast, renal, multiple myeloma and lung; squamous cell tumor invasion or metastases (1). These may occur before is the most frequently observed subtype (3-5). Osteolytic the cancer is diagnosed and can be independent in their metastases are another significant cause of hypercalcemia in severity to the stage of the primary tumor.
    [Show full text]
  • A Deep Learning System for Differential Diagnosis of Skin Diseases
    A deep learning system for differential diagnosis of skin diseases 1 1 1 1 1 1,2 † Yuan Liu ,​ Ayush Jain ,​ Clara Eng ,​ David H. Way ,​ Kang Lee ,​ Peggy Bui ,​ Kimberly Kanada ,​ ​ ​ ‡ ​ 1​ ​ 1 ​ 1 ​ Guilherme de Oliveira Marinho ,​ Jessica Gallegos ,​ Sara Gabriele ,​ Vishakha Gupta ,​ Nalini 1,3,§ 1 ​ ​ 4 ​ 1 ​ ​ 1 Singh ,​ Vivek Natarajan ,​ Rainer Hofmann-Wellenhof ,​ Greg S. Corrado ,​ Lily H. Peng ,​ Dale ​ ​ 1 1 ​ † 1, ​ 1, ​ 1, ​ R. Webster ,​ Dennis Ai ,​ Susan Huang ,​ Yun Liu *​ , R. Carter Dunn *​ *, David Coz *​ * ​ ​ ​ ​ ​ ​ Affiliations: 1 G​ oogle Health, Palo Alto, CA, USA 2 U​ niversity of California, San Francisco, CA, USA 3 M​ assachusetts Institute of Technology, Cambridge, MA, USA 4 M​ edical University of Graz, Graz, Austria † W​ ork done at Google Health via Advanced Clinical. ‡ W​ ork done at Google Health via Adecco Staffing. § W​ ork done at Google Health. *Corresponding author: [email protected] **These authors contributed equally to this work. Abstract Skin and subcutaneous conditions affect an estimated 1.9 billion people at any given time and remain the fourth leading cause of non-fatal disease burden worldwide. Access to dermatology care is limited due to a shortage of dermatologists, causing long wait times and leading patients to seek dermatologic care from general practitioners. However, the diagnostic accuracy of general practitioners has been reported to be only 0.24-0.70 (compared to 0.77-0.96 for dermatologists), resulting in over- and ​ ​ ​ ​ ​ ​ ​ under-referrals, delays in care, and errors in diagnosis and treatment. In this paper, we developed a deep learning system (DLS) to provide a differential diagnosis of skin conditions for clinical cases (skin photographs and associated medical histories).
    [Show full text]
  • Cutaneous Manifestations of Internal Malignancies in a Tertiary Health
    736 ESPECIAL L Cutaneous manifestations of internal malignancies in a tertiary health care hospital of a developing country* Manifestações cutâneas de doenças malignas em um hospital terciário de um país em desenvolvimento Alex G. Ortega-Loayza 1 Willy Ramos 2 Ericson L. Gutierrez 3 Patricia Chavez de Paz 4 Lucia Bobbio 5 Carlos Galarza 6 Abstract: In a public hospital in Lima, Peru, 24 patients with 16 types of paraneoplastic dermatoses were iden- tified by data collection. The most frequent dermatosis was dermatomyositis (four patients). The other derma- toses were malignant acanthosis nigricans, palmoplantar keratoderma, bullous dermatoses, lymphomatoid papulosis, edematous scarring vasculitic panniculitis, Norwegian scabies, primary systemic amyloidosis, necrolytic migratory erythema, infective dermatitis, pancreatic panniculitis, generalized pruritus, Lesser-Trelat syndrome, and acquired ichthyosis. Most of these paraneoplastic dermatoses were diagnosed before (45.8%) or at the time of (38.5%) the diagnosis of the underlying malignancy. The most frequent underlying malignan- cies were lymphoma, adenocarcinomas of the upper digestive tract, and malignant neoplasms of the pancreas. The average age of the patients was 47.0 ± 16.9 years and the length of the disease since diagnosis was 13.7 months. The mortality rate was 75%. Paraneoplastic dermatoses are rare dermatologic entities that are difficult to diagnose. Surveillance is also hampered when patients do not have easy access to health care centers due to financial and geographical issues. However, when identified, they might facilitate the early diagnosis of an associated tumor and contribute to increase the surveillance of patients. Keywords: Dermatomyositis; Lymphoma; Paraneoplastic syndromes Resumo: Em um hospital público em Lima, Peru, 24 pacientes com 16 tipos de dermatoses paraneoplá- sicas foram identificados por meio de coleta de dados.
    [Show full text]
  • | 2020 Aad Abstracts • Gross & Microscopic 2
    | 2020 AAD ABSTRACTS • GROSS & MICROSCOPIC | 2 GROSS & MICROSCOPIC FINALISTS Facial flushing: the dermatologist reaches for the stethoscope A 55-year-old female presented with a long history of facial flushing and erythema, previously diagnosed as rosacea and eczema. On examination she had widespread fixed erythema and telangiectasiae involving the face, chest, abdomen and proximal limbs. The differential diagnoses for her extensive rash and episodic flushing were considered, including mycosis fungoides, telangiectasia macularis eruptiva perstans, medullary thyroid carcinoma, renal cell carcinoma and carcinoid syndrome. In view of the unusual nature of the rash and diagnostic uncertainty, a comprehensive physical examination was performed in clinic and a murmur present throughout the cardiac cycle and prominent JVP were identified. The patient declined a skin biopsy. However, in view of the findings on cardiac examination, an urgent echocardiogram was requested. This revealed tricuspid and pulmonary valve fibrosis with regurgitation and right-sided atrioventricular dilatation, consistent with carcinoid heart disease. 24 hour urinary 5-HIAA and serum chromogranin A and B were significantly raised. Subsequently, cross-sectional imaging revealed multiple liver lesions and octreotide scanning showed radiotracer accumulation in these areas. Liver biopsy showed a malignant, epithelioid neoplasm, arranged in cords and nests within a fibrotic stroma. Immunohistochemistry for chromogranin, synaptophysin and CD56 were positive confirming a diagnosis of metastatic carcinoid tumour. In this case, the diagnosis of metastatic carcinoid was expedited by investigation of cardiac findings identified at her initial dermatology consultation. This highlights the importance of physical examination in the presence of unusual cutaneous findings, particularly in the absence of skin histology, and that the stethoscope may be as useful as the dermatoscope for dermatologists! References: 1.
    [Show full text]
  • Pdfs/Cosmetica/Dcm-2015/Dcm153f.Pdf Articulo=13136503&Pident Usuario=0&Pcontactid=&Pident Revista =103&Ty=112&Accion=L&Origen=Zonadelectura&Web=
    Revista Colombiana de Gastroenterologia ISSN: 0120-9957 Asociación Colombiana de Gastroenterología Rodríguez P, Laura; Yurgaky S, James; Otero R, William; Faizal, Michel Síndromes paraneoplásicos en tumores gastrointestinales. Revisión de tema Revista Colombiana de Gastroenterologia, vol. 32, núm. 3, 2017, Julio-Septiembre, pp. 230-244 Asociación Colombiana de Gastroenterología DOI: https://doi.org/10.22516/25007440.155 Disponible en: https://www.redalyc.org/articulo.oa?id=337754672006 Cómo citar el artículo Número completo Sistema de Información Científica Redalyc Más información del artículo Red de Revistas Científicas de América Latina y el Caribe, España y Portugal Página de la revista en redalyc.org Proyecto académico sin fines de lucro, desarrollado bajo la iniciativa de acceso abierto DOI: https://doi.org/10.22516/25007440.155 Revisión de tema Síndromes paraneoplásicos en tumores gastrointestinales. Revisión de tema A Review of Paraneoplastic Syndromes in Gastrointestinal Tumors Laura Rodríguez P.1, James Yurgaky S.2, William Otero R.3, Michel Faizal4 1 Médico interno, Universidad Nacional de Colombia. Resumen Bogotá (Colombia). 2 Internista, endocrinólogo, fellow de Los síndromes paraneoplásicos representan manifestaciones clínicas que producen los tumores en sitios gastroenterología, Universidad Nacional de distantes a ellos y que no están relacionadas físicamente con ellos ni con sus metástasis. Diferentes tumores Colombia, Hospital Universitario Nacional de gastrointestinales pueden presentar síndromes o manifestaciones sistémicas, dermatológicas, hematológi- Colombia. Bogotá (Colombia). 3 Profesor titular de Medicina, Unidad de cas, renales y neurológicas, entre otras. Aquí se ofrece una revisión de esas distintas manifestaciones. Gastroenterología, Universidad Nacional de Colombia, Hospital Universitario Nacional de Palabras clave Colombia; gastroenterólogo, Clínica Fundadores. Bogotá (Colombia). Síndrome paraneoplásico, gastrointestinal, tumores.
    [Show full text]
  • Review Article
    DOI: 10.14260/jemds/2014/2146 REVIEW ARTICLE SKIN MANIFESTATIONS OF GASTROINTESTINAL DISEASES: A REVIEW Manisha Nijhawan1, Puneet Agarwal2, Sandeep Nijhawan3, Prashant4, Abhishek Saini5 HOW TO CITE THIS ARTICLE: Manisha Nijhawan, Puneet Agarwal, Sandeep Nijhawan, Prashant, Abhishek Saini. “Skin Manifestations of Gastrointestinal Diseases: A Review”. Journal of Evolution of Medical and Dental Sciences 2014; Vol. 3, Issue 09, March 3; Page: 2357-2372, DOI: 10.14260/jemds/2014/2146 ABSTRACT: Skin is the largest organ of human body and stands as a guard for our internal organs. It can be regarded as a mirror giving a reflection of metabolic, biochemical and functional status of our internal organs. Dermatologists/Gastroenterologist should be aware of the dermatological manifestations as these change may be the first clue that a patient has underlying gastrointestinal (GI) or liver disease. Recognizing these signs is important in early and appropriate diagnosis. This article reviews the important dermatological manifestation of various GI and liver diseases. KEYWORDS: Skin and GI. Different dermatological manifestation in gastrointestinal diseases can be classified as:- 1) Specific skin manifestations 2) Reactive skin manifestations 3) Skin manifestations secondary to the deficiency of nutrients due to GI disease 4) Skin manifestations secondary to the treatment For clinician skin manifestation can be simply classified as- 1. Dermatological manifestations in benign GI diseases 2. Dermatological manifestations in malignant GI disease J of Evolution of Med and Dent Sci/ eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 3/ Issue 09/ Mar 3, 2014 Page 2357 DOI: 10.14260/jemds/2014/2146 REVIEW ARTICLE A: Skin manifestations in esophageal diseases: Dysphagia: Esophageal webs This is a developmental abnormality with one or more horizontal membrane in upper esophagus.
    [Show full text]
  • Cutaneous Manifestations in Pancreatic Diseases—A Review
    Journal of Clinical Medicine Review Cutaneous Manifestations in Pancreatic Diseases—A Review 1, 2,3, , 1,2 2,3 Raluca Miulescu y, Daniel Vasile Balaban * y , Florica Sandru and Mariana Jinga 1 Dermatology Department, Elias University Emergency Hospital, 011461 Bucharest, Romania; [email protected] (R.M.); fl[email protected] (F.S.) 2 Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 030167 Bucharest, Romania; [email protected] 3 Gastroenterology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, 010825 Bucharest, Romania * Correspondence: [email protected] These authors contributed equally. y Received: 13 July 2020; Accepted: 7 August 2020; Published: 12 August 2020 Abstract: Pancreatic pathology, comprising acute and chronic pancreatitis, autoimmune pancreatitis and pancreatic neoplasms, primarily presents with gastrointestinal symptoms and signs; however, it is well recognized that it can also associate a wide range of extra-digestive features. Among these systemic manifestations, cutaneous involvement plays an important role both as a diagnostic clue for the pancreatic disease itself and serving as a prognostic factor for the severity of the condition. Recognition of these cutaneous signs is, however, far from being satisfactory, all the more as some of them are relatively rare. In the current review, we discuss skin involvement in pancreatic diseases, referring to pancreatic panniculitis, cutaneous hemorrhagic manifestations, skin metastasis, acanthosis nigricans, livedo reticularis, necrolytic migratory erythema and cutaneous fistula. We highlight the clinical characteristics, treatment and prognostic value of these lesions. Better awareness among medical specialties other than dermatology is needed for detection of the skin clues associated with pancreatic pathology. Keywords: acute pancreatitis; chronic pancreatitis; pancreatic cancer; cutaneous; pancreatic panniculitis; acanthosis nigricans 1.
    [Show full text]
  • A Case of Acanthosis Nigricans As a Paraneoplastic Syndrome with Squamous Cell Lung Cancer
    Journal name: OncoTargets and Therapy Article Designation: Case report Year: 2016 Volume: 9 OncoTargets and Therapy Dovepress Running head verso: Karakas et al Running head recto: Acanthosis nigricans as a paraneoplastic syndrome open access to scientific and medical research DOI: http://dx.doi.org/10.2147/OTT.S95020 Open Access Full Text Article CASE REPORT A case of acanthosis nigricans as a paraneoplastic syndrome with squamous cell lung cancer Yusuf Karakas1 Abstract: A 55-year-old man presented with oral mucosal ulcers, blackening of both hands, Ece Esin1 and hyperpigmentation on axillary, anal, and inguinal regions for the last 3 months, which were Sahin Lacin1 all progressive. The patient was referred to the oncology department with the diagnosis of acan- Koray Ceyhan2 thosis nigricans for investigation of an underlying malignancy. He was a smoker. A computed Aylin Okcu Heper2 tomography scan of thorax revealed enlarged mediastinal lymphadenopathies and a lesion on Suayib Yalcin1 the left upper lobe. Fine-needle aspiration biopsy of the mediastinal lesion was consistent with squamous cell carcinoma, and biopsies of the skin and oral mucosal lesion also further confirmed 1 Medical Oncology Department, the diagnosis of acanthosis nigricans. After docetaxel and cisplatin chemotherapy, a significant Hacettepe University Cancer Institute, 2Department of Medical improvement in his skin and mucosal lesions was observed with almost complete resolution of Pathology, Ankara University School the pulmonary lesion and the mediastinal lymph
    [Show full text]
  • Cutaneous Manifestations of Internal Malignancy” Ashley L
    “Cutaneous Manifestations of Internal Malignancy” Ashley L. Kittridge, DO Cutaneous Manifestations of Internal Malignancy POMA Winter Conference District 8 January 2018 Ashley Kittridge, DO, FAAD No COI Disclaimer of Photos & Tables • Photos and tables adapted from multiple sources • Sources referenced on each slide and at end of presentation • Few photos are personal clinical photos • Please do not share photos used here without permission Involvement of Skin by Internal Malignancy • Direct​ (non-paraneoplastic) • Presence of tumor cells within the skin • Direct tumor extension • Metastases​ • Indirect (paraneoplastic) • No presence of tumor cells within the skin • Visceral tumors may secrete a variety of inflammatory, proliferative and/or metabolic factors that lead to cutaneous changes • Up to 20% of cancer patients experience paraneoplastic syndromes, but often unrecognized • Cutaneous manifestations may develop before a diagnosis of malignancy is determined; thus, these findings may aid the physician in the early identification of malignancy. POMA District VIII 31st Annual Educational Winter Seminar January 25-28, 2018 1 “Cutaneous Manifestations of Internal Malignancy” Ashley L. Kittridge, DO Paraneoplastic Syndrome • Curth’s Postulates​- At least one of the following: • Malignancy & cutaneous disorder are of concurrent onset • Malignancy & cutaneous disorder should follow a parallel course • Successful treatment of the malignancy leads to regression of the skin disease • Recurrence of the malignancy leads to a return of the skin
    [Show full text]
  • Can Palm Reading Pick up Cancer?
    Published online: 2021-08-11 THIEME 186 LetterLetterto to thethe EditorEditor Letter to the Editor Can Palm Reading Pick Up Cancer? Archana Baburao1 Nandini Albur Shankaraiah2 Thirthashree Kanabur1 Ajay Babu1 1Department of Pulmonary Medicine, Kempegowda Institute of Address for correspondence Medical Sciences, Bengaluru, Karnataka, India Archana Baburao, MBBS, DNB, DTCD, 2Department of Dermatology, Kempegowda Institute of Medical Department of Pulmonary Medicine, Sciences, Bengaluru, Karnataka, India Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India (e-mail: [email protected]). Archana Baburao, MBBS, DNB, DTCD South Asian J Cancer 2020;9:186–187. The association of skin with visceral cancer was first described out GI malignancies, were normal. A diagnosis of tripe palms by Hebra in 1868.1 More than 50 dermatological conditions secondary to small cell carcinoma of the lung was made and have been reported as markers of malignancy. Paraneoplastic the patient was referred to medical oncologist and started on dermatoses are heterogeneous group of clinical manifesta- intravenous etoposide and cisplatin in cycles. However, the tions that often appears benign, and they are the third most patient succumbed to cancer after 1 month. common paraneoplastic site very next to neurologic and Paraneoplastic syndromes are a group of clinical dis- endocrine syndromes.2 There is no relationship between the orders that are associated with malignant diseases and severity of symptoms and the size of the primary tumor. It are not directly related to direct invasion, obstruction, or commonly precedes or follows visceral cancer3 and early metastasis.3 Although paraneoplastic syndromes can be recognition may result in earlier diagnosis and management associated with many types of malignancies, they are most of visceral cancer.
    [Show full text]
  • Boards' Fodder
    boards’ fodder Skin Signs of Internal Malignancy By Amandeep Sandhu, MD, Caroline Perez, MD, and Sharon E. Jacob, MD Dermatologic manifestation Description Associated malignancy or syndrome (or malignancies) Acanthosis nigricans (Malignant Hyperpigmented velvety plaques, com- GI adenocarcinoma acanthosis nigricans) monly of the neck, axilla, and groin. Acquired hypertrichosis Growth of lanugo hairs. Distribution can be Various internal malignancies, most often lanuginosa specific to the face or generalized. Hairs lung, colon or breast carcinoma. can become coarser with time. Acquired ichthyosis Clinically similar to ichthyosis vulgaris, with Hodgkin lymphoma, non-Hodgkin lympho- symmetrical fine, rough scale, typically ma, multiple myeloma, mycosis fungoides, more pronounced on lower extremities. carcinomatosis. Adenopathy and extensive skin Red-brown, violaceous patch or plaque. Plasmacytoma patch overlying a plamacytoma Biopsy: dermal vascular hyperplasia with (AESOP) syndrome increased surrounding dermal mucin. Alopecia neoplastica Solitary or multiple patches or plaques Breast most common, also GI, lung, renal, of cicatricial hair loss OR non-scarring gastric, and pancreatic. resembling alopecia areata. Bazex syndrome Violaceous erythema and scaling of the Primarily squamous cell carcinoma of upper (Acrokeratosis paraneoplastica) fingers, toes, nose and aural helices. May respiratory or GI tract. see nail dystrophy or palmoplantar kera- toderma. Bullous pemphigoid Tense, fluid-filled, subepidermal bullae. Renal cell carcinoma, lung carcinoma. Aman Sandhu, MD, is PG-4 and chief Carcinoid syndrome Flushing and erythema of head and neck. GI with liver metastases. Bronchial carcinoid dermatology resident In later disease, may see sclerodermoid tumors. changes and pellagra-like dermatitis. at Loma Linda University Medical Carcinoma en cuirasse/ Means “encasement of armor;” indurated, Breast cancer most common, also stomach, sclerodermoid fibrotic, scar-like plaques to the trunk, kidneys, or lungs.
    [Show full text]
  • A Review of Paraneoplastic Syndromes in Gastrointestinal Tumors
    DOI: https://doi.org/10.22516/25007440.155 Review articles A Review of Paraneoplastic Syndromes in Gastrointestinal Tumors Laura Rodríguez P.1, James Yurgaky S.2, William Otero R.3, Michel Faizal4 1 Intern in the Faculty of Medicine at the National Abstract University of Colombia in Bogotá, Colombia 2 Internist, Endocrinologist and Gastroenterology Paraneoplastic syndromes produce tumors at sites distant from themselves and are not physically related Fellow at the National University of Colombia and the to those tumors or to their metastases. Various gastrointestinal tumors may present syndromes or systemic, National University of Colombia Hospital in Bogotá, dermatological, hematological, renal, neurological and other manifestations. This study reviews these mani- Colombia 3 Professor of Medicine in the Gastroenterology festations. Unit of the National University of Colombia and the National University of Colombia Hospital and Keywords Gastroenterologist at the Foundations Clinic in Bogotá, Colombia. Email: [email protected] Paraneoplastic syndrome, gastrointestinal, tumors. 4 Professor of Medicine in the Dermatology Unit at the National University of Colombia and the National University of Colombia Hospital in Bogotá, Colombia ......................................... Received: 25-07-16 Accepted: 28-07-17 INTRODUCTION finally result in accumulation of immune complexes. (3, 4, 5) The various PNS are classified according to the organ or Paraneoplastic syndromes (PNS) are a heterogeneous system they affect as endocrine and metabolic, dermato- group of clinical manifestations that occur when a tumor logical, hematological, rheumatological and neurological. causes damage to a distant organ or system and that are not (3) This review describes PNS produced by gastrointesti- physically related to the tumor or its metastases.
    [Show full text]